Women with Low-Risk DCIS Eligible for the LORIS Trial After Complete Surgical Excision: How Low Is Their Risk After Standard Therapy?
Women with Low-Risk DCIS Eligible for the LORIS Trial After Complete Surgical Excision: How Low Is Their Risk After Standard Therapy?
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DOI：
10.1245/s10434-016-5595-3
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发表时间：
2016-12-01
影响因子：
3.7
通讯作者：
Van Zee, Kimberly J.
中科院分区：
文献类型：
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作者：
Pilewskie, Melissa;Olcese, Cristina;Van Zee, Kimberly J.
识别疾病进展风险低的DCIS患者可能不需要标准治疗。洛里斯（手术与主动监测低风险DCIS）试验正在研究监测低风险DCIS的安全性，尽管完全手术切除后符合入选标准的患者的同侧乳腺肿瘤复发率（IBTR）尚不清楚。1996年1月至1999年1月，从前瞻性维护的数据库中纳入2011年的数据。在完全手术切除后，比较符合和不符合洛里斯标准（年龄46岁，筛查发现钙化，无乳头溢液，家族史最少，非高级别洛里斯）的患者的IBTR率。中位随访时间为5.9年; 431例接受了10年随访。洛里斯队列中位年龄为61岁（范围46-86岁）; 207例（52%）接受了RT，79例（20%）接受了内分泌治疗。在401例患者中，24例发生IBTR。总体10年IBTR率为10.3%（洛里斯）与15.4%（非LORIS）（p = 0.08）;无RT时，分别为12.1%与21.4%（p = 0.06）。符合洛里斯标准的女性的10年侵袭性IBTR率为：总体BCS为5.3%，无RT为6.0%。符合洛里斯标准的女性（完全手术切除后）IBTR的风险较低。在这些未经RT接受切除的女性中，10年侵入性IBTR率为6%。考虑到约20%的核心活检证实的非高级别DCIS女性在切除时患有浸润性癌症，预计未经切除治疗的女性会导致更高的浸润性癌症发生率。需要额外的标准来识别不需要DCIS干预的女性。
Identifying DCIS patients at low risk for disease progression could obviate need for standard therapy. The LORIS (surgery versus active monitoring for low-risk DCIS) trial is studying the safety of monitoring low-risk DCIS, although ipsilateral breast tumor recurrence (IBTR) rates in patients meeting enrollment criteria after complete surgical excision are unknown.Women with pure DCIS treated with breast-conserving surgery (BCS) with/without radiation therapy (RT) from 1/1996-1/2011 were included from a prospectively maintained database. IBTR rates were compared between those who did and did not meet LORIS eligibility criteria (age aeyen 46 years, screen-detected calcifications, nipple discharge absence, minimal family history, non-high-grade DCIS) after complete surgical excision.A total of 2394 women were identified; 401 met LORIS criteria. Median follow-up was 5.9 years; 431 had aeyen10 years follow-up. LORIS cohort median age was 61 years (range 46-86 years); 207 (52 %) underwent RT, 79 (20 %) received endocrine therapy. Of 401 patients, 24 experienced an IBTR. Overall 10-year IBTR rates were 10.3 % (LORIS) versus 15.4 % (non-LORIS) (p = 0.08); without RT, 12.1 versus 21.4 %, respectively (p = 0.06). The 10-year invasive-IBTR rates for women meeting LORIS criteria were: 5.3 % BCS overall, 6.0 % without RT.Women meeting LORIS criteria (after complete surgical excision) are at somewhat lower risk for IBTR. Among such women undergoing excision without RT, the 10-year invasive-IBTR rate was 6 %. Given that approximately 20 % of women with core biopsy-proven non-high-grade DCIS have invasive cancer at excision, women managed without excision would be expected to incur higher invasive cancer rates. Additional criteria are needed to identify women not requiring intervention for DCIS.